Sonomat, invented by the University of Sydney's Colin Sullivan, could revolutionise the diagnosis and monitoring of sleep disorders from within the home.

Sonomat, invented by the University of Sydney's Colin Sullivan, is a mat - containing sensors - that lies on the mattress.

It records sounds from the sleeper's heart and lungs to diagnose sleep disorders such as sleep apnoea. It can also lead to the early diagnosis of asthma. Sonomat can be used in the home, obviating the need for stints in sleep clinics and for wiring the patient up to external probes, a procedure that distresses children.

Sullivan says there is some evidence suggesting that sleep disorders can affect cognitive development in early childhood.

The technology has undergone clinical trials and is in the early stages of commercialisation

A device that could revolutionise the diagnosis and monitoring of sleep disorders from within the home

PROFESSOR COLIN SULLIVAN: Sleep is a time of vulnerability so it has now become literally a standard part of a physical assessment is to see how you are functioning in sleep.

DESLEY BLANCH: Meet Colin Sullivan. He’s one of Australia’s leading medical researchers into sleep disorders and is the inventor of the nasal CPAP technology used to treat sleep apnoea. His latest technology is Sonomat which he believes will be at the front end of healthcare in the home. Eventually it could be used to trigger an alarm if you have a medical emergency such as an asthma or heart attack.

PROFESSOR COLIN SULLIVAN : The mat is actually a thin mat that goes on an ordinary bed and then the subject just makes the bed as usual. But the mat contains sensors which have a high sensitivity and really detect vibration and sounds. It’s a little like a patient lying on a bed and literally with a range of stethoscopes in contact with them but through the bed sheet and through their ordinary clothes and they can still move around.

The sensors actually measure movement, they measure breathing movement, heart movement but also breathing sounds and heart sounds. These are normally inaudible and, of course a physician will use a stethoscope placed on the chest to hear these things, but these sensors actually pick those sounds up.

We have used mats for years to try and measure breathing at home and I started doing that, trying to have a look at sudden infant deaths, but all we could measure were really fairly low level movements, like you could certainly measure breathing movement, but crucial to know what’s really going on as you have to hear what the breath sounds are; whether there’s wheezing, whether they are snoring, and heart sounds and whether there are murmurs. And that’s what we finally got to, if you , in this mat system. It’s relied on the development of electronics and digital recordings etc.

DESLEY BLANCH : Yes, you’ve been one of the pioneers of sleep science and you’ve been central to the establishment of Australia’s first sleep clinics and also you’ve been involved in Sudden Infant Death Syndrome from way back in the early 1970s. So I suppose, is Sonomat a tool to help researchers track down the cause of sudden infant death syndrome?

PROFESSOR COLIN SULLIVAN : Yes, I think it is, although currently that’s not most of our focus. Part of the reason it’s not the focus although I’m still vitally interested in it, it’s sort of looking for a needle in a haystack, although at the time I got to start in that area the rate of sudden infant death in Australia was relatively high. It‘s dropped dramatically almost certainly because of the “Back to Sleep” campaign. However, there are many children, the infants, still die in this way.

However, most of our efforts have been looking at slightly older children, because we’ve known for a long time that the sort of obstructed snoring that up to 9 or 10 per cent of all children around four or five have, is clearly associated with cognitive delay and also sets the children up to have abnormal vascular responses when they get older.

So, currently the way we still do studies in children is to bring them into a sleep laboratory, but the Sonomat is actually going to change that. We’ve now been using it routinely to study children at home.

DESLEY BLANCH : And this is looking for the early detection and monitoring of diseases and we’ve named asthma and cardiovascular and lung diseases.

ROFESSOR COLIN SULLIVAN : That’s right. One of the things that we’ve realised over the last 10, 15 years is most of these disorders often get worse in sleep, that’s particularly the case with conditions like asthma, it’s particularly the case with many, many heart diseases like cardiac failure and, we know that part of that getting worse is some degree of upper airway obstruction during sleep.

It’s quite remarkable, if you into a heart clinic, we know that literally half to 60 per cent of all patients who are coming along because of their heart arrhythmias or high blood pressure or heart attack or heart failure, half of them are going to have very significant sleep disordered breathing and pretty well all of that is being missed at the moment.

One of the reasons it’s missed, it’s very hard using the current approach to evaluating what’s going on in sleep, it’s hard to do it, but the sleep laboratory is a great facility, but there simply are not and will never be enough to deal with the numbers of patients.

The Sonomat really is a completely new way of looking at it where the person themselves does this test, but we’ve got it to a point where we get sufficient information so we know what’s going on and you don’t in many cases won’t need to do a traditional sleep study. It’s really changing the whole paradigm of how we approach this.

DESLEY BLANCH : So you’ve got virtual physicians, so-called, they’re monitoring. So when do the live physicians step into the whole process?

PROFESSOR COLIN SULLIVAN : At the moment, the version we’ve got approved through the Australian regulatory system is the take home device which records all the data onto an SD card, so the clinician looks at the data the next day. However, we have in prototype form and have tested earlier versions where it’s linked up via the phone or the internet to a remote site.

One of the versions that will come out of this is it’s linked through broadband, so that a remote clinician or a nurse or a physician can simply go and look at what’s going on at 2 o’clock in the morning, that’s where it’s going.

Now we have developed and are developing a whole lot of intelligent algorithms that look at the recordings and are able to flag events that need looking at, but it’s going to take us a while before we get that approved, because to get it approved as a virtual physician requires that we have to have a very careful and detailed validation so that we either miss events and we don’t over-report events.

DESLEY BLANCH : Yes, that would be one of the critical things of the software that’s driving it, because you’re using that software to identify and analyse this sound data that’s coming in from the patient. And I wonder how you’ve developed this software to know how to recognise different diseases through sound signals?

PROFESSOR COLIN SULLIVAN : Well, we’ve collected studies now on many, many hundreds, in fact over some thousands of patients with various disorders, so we have already got profiles of the sort of things that we as clinicians -- if I were there at 2 o’clock in the morning and examining a kid with asthma, for instance. I’d know that they’re having an asthma attack.

So we’ve actually got examples of pretty well most of these from which we are extracting the signatures and we’re pretty good at it detecting these things. However, before we get regulatory approval, we have to go through quite an arduous process of complete validation.

I can say that its use already, though has really dramatically improved how we manage a lot of conditions, particularly the childhood sleep disordered breathing. Part of the problem at the moment is that, for instance, one of the biggest paediatric facilities in Sydney which does sleep tests on children;a child may not have a study for 18 months which is sort of ridiculous, so, the mat allows us to do these studies very quickly and very easily at home, so that’s, if you like, that’s where we’re at with it at the moment. The use of it for long term monitoring in the home is a little way off yet, but we see it’s going to come very quickly, particularly with the advent of access to broadband, which it requires, because of the data flow.

DESLEY BLANCH : Exactly. But you have found another major role for Sonomat in monitoring pregnant women and identifying problems in pregnancy. Tell us how you’re using that, because you’re using it locally now in Sydney.

PROFESSOR COLIN SULLIVAN : That’s right. Well, we discovered some years ago and a number of groups around the world found that women in the last trimester tend to snore, but our particular discovery was that virtually all women with pre-eclampsia the high blood pressure of pregnancy have a particular type of snoring for most of the night, more than half of the night and when they do that, it’s really a major trigger factor pushing their blood pressure sky high.

So, when we actually controlled the blood pressure using the C-PAP system, the positive pressure breathing system, with really gentle levels of pressure, the blood pressure would come down.

So the problem in this area is -- well, how do you when you see a woman who comes in with pre-eclampsia, how do you work out whether this particular problem is present? And, of course, currently the standard methods simply don’t manage it. You can’t book a woman who is 28 weeks and has got oedema and some blood pressure, you can’t book them into a sleep lab; you have to find out tonight what’s going on.

o we’ve been using the Sonomat for that purpose, so a woman can take it home from the clinic, they do the study on themselves, and we know the next day whether they’ve got this type of snoring and obstructed breathing and they can be onto the treatment immediately. And that’s I see probably one of its major uses, at least at this point in time.

DESLEY BLANCH : So you really do see this technology as being at the front end of health care in the home, because they’re taking it home and they’re using it there. And you’ve got the children at home, you’ve got everyone at home and that technology and information is coming back to you for monitoring. It sounds an absolutely marvellous thing. The online alarm system - what’s your guesstimate for when we might reach for this stage?

PROFESSOR COLIN SULLIVAN : Well, we already have the capacity to do it. The main issue for us is the development of the validations, but we will be trialling some versions of this in the latter part of this year.

One of the things that is happening in health care as people probably know, is that a lot more health care is being put out into the home. So, people measure their own breathing capacity, their blood pressure, diabetic control, for instance, and we see this technology as really adding to that in a very positive way. So that the future of health care will involve the person themselves taking a big role in it so that they will make sure they’re involved in seeing what’s going on, as well as actually having backup from nurses and physicians remotely. So those physicians might be on the other side of the world, but the systems are going to be in place where that’s going to help manage large numbers of people with fewer humans, if you like, but with advanced technology.

DESLEY BLANCH : So our listeners in Asia and the Pacific, they too can join in this quite easily?

PROFESSOR COLIN SULLIVAN : Absolutely. We certainly see it being done across continents. We already, for instance in Australia, a lot of our colleagues in India do a lot of the sleep scoring that’s done in many of the sleep labs, so we see a higher level of this, if you like, occurring with this type of technology, so that where the health care professionals might be on the other side of the world, and literally it’s going to be possible for people who are awake because of the time zone difference can be looking after the people on the other side of the world who are asleep.

DESLEY BLANCH : Colin Sullivan is Professor of Medicine at the Central Clinical School at the University of Sydney from where he describes how Sonomat could revolutionise the diagnosis and monitoring of sleep disorders from within the home.
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Validation of the sonomat: a contactless monitoring system used for the diagnosis of sleep disordered breathing.
Full text: http://www.researchgate.net/publication/..._breathing

Monitoring all those body sounds is probably as good as the events they now monitor in that kludge called a "sleep study". The idea sounds reasonable. (pardon the pun)

I have posted a few times on how I slept with a small digital audio recorder taped to my tee-shirt to determine that I had sleep apnea before going to a sleep doctor. Old Colin is taking that concept much further and running with it. More power to him! It's also nice that it may help prevent infant deaths due to SIDS.

I look forward to a day when a sleep test is performed in the home with a small device that doesn't have to attach to the body. Colin may be able to make that a reality. No doubt he will meet much resistance from the medical mafia.

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